COPD patients with ventilator-associated pneumonia: implications for management.
Identifieur interne : 003092 ( Main/Exploration ); précédent : 003091; suivant : 003093COPD patients with ventilator-associated pneumonia: implications for management.
Auteurs : D. Koulenti [Grèce] ; S. Blot [Australie] ; J M Dulhunty [Australie] ; L. Papazian [France] ; I. Martin-Loeches [Espagne] ; G. Dimopoulos [Grèce] ; C. Brun-Buisson [France] ; M. Nauwynck [Belgique] ; C. Putensen [Allemagne] ; J. Sole-Violan [Espagne] ; A. Armaganidis [Grèce] ; J. Rello [Espagne]Source :
- European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology [ 1435-4373 ] ; 2015.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Analyse de survie, Antibactériens (usage thérapeutique), Broncho-pneumopathie chronique obstructive (), Europe (épidémiologie), Femelle, Humains, Mâle, Pneumopathie infectieuse sous ventilation assistée (microbiologie), Pneumopathie infectieuse sous ventilation assistée (mortalité), Pneumopathie infectieuse sous ventilation assistée (traitement médicamenteux), Pneumopathie infectieuse sous ventilation assistée (épidémiologie), Pseudomonas aeruginosa (isolement et purification), Résultat thérapeutique, Sujet âgé, Sujet âgé de 80 ans ou plus, Unités de soins intensifs, Études prospectives.
- MESH :
- isolement et purification : Pseudomonas aeruginosa.
- microbiologie : Pneumopathie infectieuse sous ventilation assistée.
- mortalité : Pneumopathie infectieuse sous ventilation assistée.
- traitement médicamenteux : Pneumopathie infectieuse sous ventilation assistée.
- usage thérapeutique : Antibactériens.
- épidémiologie : Europe, Pneumopathie infectieuse sous ventilation assistée.
- Adulte, Adulte d'âge moyen, Analyse de survie, Broncho-pneumopathie chronique obstructive, Femelle, Humains, Mâle, Résultat thérapeutique, Sujet âgé, Sujet âgé de 80 ans ou plus, Unités de soins intensifs, Études prospectives.
English descriptors
- KwdEn :
- Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents (therapeutic use), Europe (epidemiology), Female, Humans, Intensive Care Units, Male, Middle Aged, Pneumonia, Ventilator-Associated (drug therapy), Pneumonia, Ventilator-Associated (epidemiology), Pneumonia, Ventilator-Associated (microbiology), Pneumonia, Ventilator-Associated (mortality), Prospective Studies, Pseudomonas aeruginosa (isolation & purification), Pulmonary Disease, Chronic Obstructive (complications), Survival Analysis, Treatment Outcome.
- MESH :
- chemical , therapeutic use : Anti-Bacterial Agents.
- geographic , epidemiology : Europe.
- complications : Pulmonary Disease, Chronic Obstructive.
- drug therapy : Pneumonia, Ventilator-Associated.
- epidemiology : Pneumonia, Ventilator-Associated.
- isolation & purification : Pseudomonas aeruginosa.
- microbiology : Pneumonia, Ventilator-Associated.
- mortality : Pneumonia, Ventilator-Associated.
- Adult, Aged, Aged, 80 and over, Female, Humans, Intensive Care Units, Male, Middle Aged, Prospective Studies, Survival Analysis, Treatment Outcome.
Abstract
Data on the occurrence and outcome of patients with chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP) are quite limited. The aim of this study was to determine if COPD intensive care unit (ICU) patients have a higher rate of VAP development, different microbiological aetiology or have worse outcomes than other patients without VAP. A secondary analysis of a large prospective, observational study conducted in 27 European ICUs was carried out. Trauma patients were excluded. Of 2082 intubated patients included in the study, 397 (19.1%) had COPD; 79 (19.9%) patients with COPD and 332 (19.7%) patients without COPD developed VAP. ICU mortality increased by 17% (p < 0.05) when COPD patients developed VAP, remaining an independent predictor of mortality [odds ratio (OR) 2.28; 95% confidence interval (CI) 1.35-3.87]. The development of VAP in COPD patients was associated with a median increase of 12 days in the duration of mechanical ventilation and >13 days in ICU stay (p < 0.05). Pseudomonas aeruginosa was more common in VAP when COPD was present (29.1% vs. 18.7%, p = 0.04) and was the most frequent isolate in COPD patients with early-onset VAP, with a frequency 2.5 times higher than in patients without early-onset VAP (33.3% vs. 13.3%, p = 0.03). COPD patients are not more predisposed to VAP than other ICU patients, but if COPD patients develop VAP, they have a worse outcome. Antibiotic coverage for non-fermenters needs to be included in the empiric therapy of all COPD patients, even in early-onset VAP.
DOI: 10.1007/s10096-015-2495-6
PubMed: 26407622
Affiliations:
- Allemagne, Australie, Belgique, Espagne, France, Grèce
- Attique (région), Catalogne, District de Cologne, Rhénanie-du-Nord-Westphalie, Île-de-France
- Athènes, Barcelone, Bonn, Paris
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Le document en format XML
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Koulenti</name><affiliation wicri:level="3"><nlm:affiliation>2nd Critical Care Department, Attikon University Hospital, Athens, Greece.</nlm:affiliation><country xml:lang="fr">Grèce</country><wicri:regionArea>2nd Critical Care Department, Attikon University Hospital, Athens</wicri:regionArea><placeName><settlement type="city">Athènes</settlement><region nuts="2" type="region">Attique (région)</region></placeName></affiliation></author><author><name sortKey="Blot, S" sort="Blot, S" uniqKey="Blot S" first="S" last="Blot">S. Blot</name><affiliation wicri:level="1"><nlm:affiliation>Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia. stijn.blot@UGent.be.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane</wicri:regionArea><wicri:noRegion>Brisbane</wicri:noRegion></affiliation></author><author><name sortKey="Dulhunty, J M" sort="Dulhunty, J M" uniqKey="Dulhunty J" first="J M" last="Dulhunty">J M Dulhunty</name><affiliation wicri:level="1"><nlm:affiliation>Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane</wicri:regionArea><wicri:noRegion>Brisbane</wicri:noRegion></affiliation></author><author><name sortKey="Papazian, L" sort="Papazian, L" uniqKey="Papazian L" first="L" last="Papazian">L. Papazian</name><affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care Medicine, Réanimation des Détresses Respiratoires et Infections Sévères Hôpital Nord-Assistance Publique-Hôpitaux de Marseille Aix-Marseille Université, Μarseille, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Intensive Care Medicine, Réanimation des Détresses Respiratoires et Infections Sévères Hôpital Nord-Assistance Publique-Hôpitaux de Marseille Aix-Marseille Université, Μarseille</wicri:regionArea><wicri:noRegion>Μarseille</wicri:noRegion><wicri:noRegion>Μarseille</wicri:noRegion></affiliation></author><author><name sortKey="Martin Loeches, I" sort="Martin Loeches, I" uniqKey="Martin Loeches I" first="I" last="Martin-Loeches">I. Martin-Loeches</name><affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care Medicine, Corporació Sanitària Parc Taulí, Sabadell, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Intensive Care Medicine, Corporació Sanitària Parc Taulí, Sabadell</wicri:regionArea><wicri:noRegion>Sabadell</wicri:noRegion></affiliation></author><author><name sortKey="Dimopoulos, G" sort="Dimopoulos, G" uniqKey="Dimopoulos G" first="G" last="Dimopoulos">G. Dimopoulos</name><affiliation wicri:level="3"><nlm:affiliation>2nd Critical Care Department, Attikon University Hospital, Athens, Greece.</nlm:affiliation><country xml:lang="fr">Grèce</country><wicri:regionArea>2nd Critical Care Department, Attikon University Hospital, Athens</wicri:regionArea><placeName><settlement type="city">Athènes</settlement><region nuts="2" type="region">Attique (région)</region></placeName></affiliation></author><author><name sortKey="Brun Buisson, C" sort="Brun Buisson, C" uniqKey="Brun Buisson C" first="C" last="Brun-Buisson">C. Brun-Buisson</name><affiliation wicri:level="3"><nlm:affiliation>Department of Intensive Care Medicine, Henri-Mondor University Hospital, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Intensive Care Medicine, Henri-Mondor University Hospital, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Nauwynck, M" sort="Nauwynck, M" uniqKey="Nauwynck M" first="M" last="Nauwynck">M. Nauwynck</name><affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care Medicine, St. Jan Hospital, Bruges, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care Medicine, St. Jan Hospital, Bruges</wicri:regionArea><wicri:noRegion>Bruges</wicri:noRegion></affiliation></author><author><name sortKey="Putensen, C" sort="Putensen, C" uniqKey="Putensen C" first="C" last="Putensen">C. Putensen</name><affiliation wicri:level="3"><nlm:affiliation>Department of Intensive Care Medicine, Bonn University Hospital, Bonn, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Intensive Care Medicine, Bonn University Hospital, Bonn</wicri:regionArea><placeName><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Cologne</region><settlement type="city">Bonn</settlement></placeName></affiliation></author><author><name sortKey="Sole Violan, J" sort="Sole Violan, J" uniqKey="Sole Violan J" first="J" last="Sole-Violan">J. Sole-Violan</name><affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care Medicine, Dr. Negrin University Hospital, Las Palmas, Gran Canaria, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Intensive Care Medicine, Dr. Negrin University Hospital, Las Palmas, Gran Canaria</wicri:regionArea><wicri:noRegion>Gran Canaria</wicri:noRegion></affiliation></author><author><name sortKey="Armaganidis, A" sort="Armaganidis, A" uniqKey="Armaganidis A" first="A" last="Armaganidis">A. Armaganidis</name><affiliation wicri:level="3"><nlm:affiliation>2nd Critical Care Department, Attikon University Hospital, Athens, Greece.</nlm:affiliation><country xml:lang="fr">Grèce</country><wicri:regionArea>2nd Critical Care Department, Attikon University Hospital, Athens</wicri:regionArea><placeName><settlement type="city">Athènes</settlement><region nuts="2" type="region">Attique (région)</region></placeName></affiliation></author><author><name sortKey="Rello, J" sort="Rello, J" uniqKey="Rello J" first="J" last="Rello">J. Rello</name><affiliation wicri:level="3"><nlm:affiliation>Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Critical Care Department, Vall d'Hebron University Hospital, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author></analytic><series><title level="j">European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology</title><idno type="eISSN">1435-4373</idno><imprint><date when="2015" type="published">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Anti-Bacterial Agents (therapeutic use)</term><term>Europe (epidemiology)</term><term>Female</term><term>Humans</term><term>Intensive Care Units</term><term>Male</term><term>Middle Aged</term><term>Pneumonia, Ventilator-Associated (drug therapy)</term><term>Pneumonia, Ventilator-Associated (epidemiology)</term><term>Pneumonia, Ventilator-Associated (microbiology)</term><term>Pneumonia, Ventilator-Associated (mortality)</term><term>Prospective Studies</term><term>Pseudomonas aeruginosa (isolation & purification)</term><term>Pulmonary Disease, Chronic Obstructive (complications)</term><term>Survival Analysis</term><term>Treatment Outcome</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse de survie</term><term>Antibactériens (usage thérapeutique)</term><term>Broncho-pneumopathie chronique obstructive ()</term><term>Europe (épidémiologie)</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Pneumopathie infectieuse sous ventilation assistée (microbiologie)</term><term>Pneumopathie infectieuse sous ventilation assistée (mortalité)</term><term>Pneumopathie infectieuse sous ventilation assistée (traitement médicamenteux)</term><term>Pneumopathie infectieuse sous ventilation assistée (épidémiologie)</term><term>Pseudomonas aeruginosa (isolement et purification)</term><term>Résultat thérapeutique</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Unités de soins intensifs</term><term>Études prospectives</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Bacterial Agents</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Europe</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Pulmonary Disease, Chronic Obstructive</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Pneumonia, Ventilator-Associated</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Pneumonia, Ventilator-Associated</term></keywords><keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>Pseudomonas aeruginosa</term></keywords><keywords scheme="MESH" qualifier="isolement et purification" xml:lang="fr"><term>Pseudomonas aeruginosa</term></keywords><keywords scheme="MESH" qualifier="microbiologie" xml:lang="fr"><term>Pneumopathie infectieuse sous ventilation assistée</term></keywords><keywords scheme="MESH" qualifier="microbiology" xml:lang="en"><term>Pneumonia, Ventilator-Associated</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Pneumonia, Ventilator-Associated</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Pneumopathie infectieuse sous ventilation assistée</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Pneumopathie infectieuse sous ventilation assistée</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antibactériens</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Europe</term><term>Pneumopathie infectieuse sous ventilation assistée</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Female</term><term>Humans</term><term>Intensive Care Units</term><term>Male</term><term>Middle Aged</term><term>Prospective Studies</term><term>Survival Analysis</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse de survie</term><term>Broncho-pneumopathie chronique obstructive</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Résultat thérapeutique</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Unités de soins intensifs</term><term>Études prospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Data on the occurrence and outcome of patients with chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP) are quite limited. The aim of this study was to determine if COPD intensive care unit (ICU) patients have a higher rate of VAP development, different microbiological aetiology or have worse outcomes than other patients without VAP. A secondary analysis of a large prospective, observational study conducted in 27 European ICUs was carried out. Trauma patients were excluded. Of 2082 intubated patients included in the study, 397 (19.1%) had COPD; 79 (19.9%) patients with COPD and 332 (19.7%) patients without COPD developed VAP. ICU mortality increased by 17% (p < 0.05) when COPD patients developed VAP, remaining an independent predictor of mortality [odds ratio (OR) 2.28; 95% confidence interval (CI) 1.35-3.87]. The development of VAP in COPD patients was associated with a median increase of 12 days in the duration of mechanical ventilation and >13 days in ICU stay (p < 0.05). Pseudomonas aeruginosa was more common in VAP when COPD was present (29.1% vs. 18.7%, p = 0.04) and was the most frequent isolate in COPD patients with early-onset VAP, with a frequency 2.5 times higher than in patients without early-onset VAP (33.3% vs. 13.3%, p = 0.03). COPD patients are not more predisposed to VAP than other ICU patients, but if COPD patients develop VAP, they have a worse outcome. Antibiotic coverage for non-fermenters needs to be included in the empiric therapy of all COPD patients, even in early-onset VAP.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Belgique</li><li>Espagne</li><li>France</li><li>Grèce</li></country><region><li>Attique (région)</li><li>Catalogne</li><li>District de Cologne</li><li>Rhénanie-du-Nord-Westphalie</li><li>Île-de-France</li></region><settlement><li>Athènes</li><li>Barcelone</li><li>Bonn</li><li>Paris</li></settlement></list><tree><country name="Grèce"><region name="Attique (région)"><name sortKey="Koulenti, D" sort="Koulenti, D" uniqKey="Koulenti D" first="D" last="Koulenti">D. Koulenti</name></region><name sortKey="Armaganidis, A" sort="Armaganidis, A" uniqKey="Armaganidis A" first="A" last="Armaganidis">A. Armaganidis</name><name sortKey="Dimopoulos, G" sort="Dimopoulos, G" uniqKey="Dimopoulos G" first="G" last="Dimopoulos">G. Dimopoulos</name></country><country name="Australie"><noRegion><name sortKey="Blot, S" sort="Blot, S" uniqKey="Blot S" first="S" last="Blot">S. Blot</name></noRegion><name sortKey="Dulhunty, J M" sort="Dulhunty, J M" uniqKey="Dulhunty J" first="J M" last="Dulhunty">J M Dulhunty</name></country><country name="France"><noRegion><name sortKey="Papazian, L" sort="Papazian, L" uniqKey="Papazian L" first="L" last="Papazian">L. Papazian</name></noRegion><name sortKey="Brun Buisson, C" sort="Brun Buisson, C" uniqKey="Brun Buisson C" first="C" last="Brun-Buisson">C. Brun-Buisson</name></country><country name="Espagne"><noRegion><name sortKey="Martin Loeches, I" sort="Martin Loeches, I" uniqKey="Martin Loeches I" first="I" last="Martin-Loeches">I. Martin-Loeches</name></noRegion><name sortKey="Rello, J" sort="Rello, J" uniqKey="Rello J" first="J" last="Rello">J. Rello</name><name sortKey="Sole Violan, J" sort="Sole Violan, J" uniqKey="Sole Violan J" first="J" last="Sole-Violan">J. Sole-Violan</name></country><country name="Belgique"><noRegion><name sortKey="Nauwynck, M" sort="Nauwynck, M" uniqKey="Nauwynck M" first="M" last="Nauwynck">M. Nauwynck</name></noRegion></country><country name="Allemagne"><region name="Rhénanie-du-Nord-Westphalie"><name sortKey="Putensen, C" sort="Putensen, C" uniqKey="Putensen C" first="C" last="Putensen">C. Putensen</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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